Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing

Văcărescu, Cristina; Luca, Constantin-Tudor; Feier, Horéa; Gaiță, Dan; Crişan, Simina; Negru, Alina Gabriela; Iurciuc, Stela; Goanță, Emilia-Violeta; Mornos, C.; Lazar, Mihai-Andrei; Streian, C; Bordejevic, Diana Aurora; Turi, Vladiana; Cozma, D.

doi:10.3390/diagnostics12051096

Cited by 9 publications

(4 citation statements)

References 36 publications

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“…A recently published article underlines the importance of ET in tailoring beta-blockers and ivabradine in CRT fusion pacing. Monitoring dynamic changes of the HR over time can help evaluate the efficacy of treatment regimens and guide adjustments as needed [ 58 ]. Therefore, our perspectives may shift towards better HRR comprehension, which may be useful in guiding medical treatment in HF patients.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Recovery: Up to Date in Heart Failure—A Literature Review

Cozgarea,

Cozma,

Teodoru

et al. 2024

JCM

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The rising prevalence of cardiovascular disease underscores the growing significance of heart failure (HF). Pathophysiological insights into HF highlight the dysregulation of the autonomic nervous system (ANS), characterized by sympathetic overactivity and diminished vagal tone, impacting cardiovascular function. Heart rate recovery (HRR), a metric measuring the heart’s ability to return to its baseline rate post-exertion, plays a crucial role in assessing cardiovascular health. Widely applied across various cardiovascular conditions including HF, coronary artery disease (CAD), and arterial hypertension (HTN), HRR quantifies the difference between peak and recovery heart rates. Given its association with elevated sympathetic tone and exercise, HRR provides valuable insights into the perspective of HF, beyond effort tolerance, reaching toward prognostic and mortality indicators. Incorporating HRR into cardiovascular evaluations enhances our understanding of autonomic regulation in HF, offering potential implications for prognostication and patient management. This review addresses the significance of HRR in HF assessment, analyzing recently conducted studies, and providing a foundation for further research and clinical application.

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Section: Discussionmentioning

confidence: 99%

Heart Rate Recovery: Up to Date in Heart Failure—A Literature Review

Cozgarea,

Cozma,

Teodoru

et al. 2024

JCM

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“…Avoiding RV pacing may substantially increase the structural response rate by shortening LV activation time [ 78 ]. Moreover, different ”degrees” of LV only fusion, according to AV node variability and heart rate, seem to play an important role in the LV remodelling process, and post-implantation optimization by targeting electrical dyssynchrony can improve CRT response in non-responder patients [ 79 , 80 ]. In consequence, understanding all components of cardiac dyssynchrony is essential not only in patient selection, but also in choosing the best CRT pacing modality.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Analysis of Apical Rocking and Septal Flash: Two Views of the Same Systole?

Lazăr-Höcher,

Cozma,

Cirin

et al. 2024

JCM

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Heart failure (HF) is a complex medical condition characterized by both electrical and mechanical dyssynchrony. Both dyssynchrony mechanisms are intricately linked together, but the current guidelines for cardiac resynchronization therapy (CRT) rely only on the electrical dyssynchrony criteria, such as the QRS complex duration. This possible inconsistency may result in undertreating eligible individuals who could benefit from CRT due to their mechanical dyssynchrony, even if they fail to fulfill the electrical criteria. The main objective of this literature review is to provide a comprehensive analysis of the practical value of echocardiography for the assessment of left ventricular (LV) dyssynchrony using parameters such as septal flash and apical rocking, which have proven their relevance in patient selection for CRT. The secondary objectives aim to offer an overview of the relationship between septal flash and apical rocking, to emphasize the primary drawbacks and benefits of using echocardiography for evaluation of septal flash and apical rocking, and to offer insights into potential clinical applications and future research directions in this area. Conclusion: there is an opportunity to render resynchronization therapy more effective for every individual; septal flash and apical rocking could be a very useful and straightforward echocardiography resource.

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“…A slight increase in blood pressure by incremental cardiac output following administration of ivabradine would give us a further chance to up-titrate beta-blockers [24]. The potentially beneficial effects of PR interval-guided beta-blocker up-titration for recipients of cardiac resynchronization therapy have been reported [25].…”

Section: Clinical Perspectivementioning

confidence: 99%

PR Interval as a Novel Therapeutic Target of Ivabradine Therapy—Prognostic Impact of Ivabradine-Induced PR Prolongation in Heart Failure Patients

Yamamoto,

Kataoka,

Imamura

et al. 2024

JCM

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Background: Ivabradine reduces heart rate by inhibiting the “funny current” expressed on the sinoatrial node and improves mortality and morbidity in patients with systolic heart failure and sinus tachycardia. The funny current is known to be expressed also on the atrioventricular node according to experimental studies. However, the impact of ivabradine on PR interval remained unknown. Methods: Patients with a left ventricular ejection fraction of less than 50% who received 1 month of ivabradine were screened. Electrocardiographic and echocardiographic data, particularly concerning heart rate, the PR interval, and trans-mitral flow pattern, were collected at baseline and 1-month follow-up. The primary endpoint was defined as the composite of cardiovascular death and hospital readmission for worsening heart failure following ivabradine administration. Results: In the cohort of 29 enrolled patients (median age: 66 years, 62% male), the median baseline heart rate was 86 beats per minute and the median PR interval was 168 milliseconds. Following ivabradine administration, a significant decrease of 20 beats per minute in the heart rate and a significant increase of 24 milliseconds in the PR interval were observed. The truncated interval of the A-wave, detected in the trans-mitral flow, consistently demonstrated a negative correlation with the PR interval both before and after the administration of ivabradine. During a median of 1.8 years of follow-up, six patients reached the primary endpoint. A combination of heart rate reduction and PR prolongation following ivabradine administration, both of which were independent factors associated with the primary endpoint (p < 0.05 for both), was associated with greater freedom from the primary endpoint compared with either/neither of them (p = 0.002). Conclusions: Ivabradine seems to prolong PR interval, which is a novel surrogate marker of favorable clinical outcomes in patients with systolic heart failure. This effect may be associated with the dynamics of the trans-mitral flow pattern, in conjunction with heart rate and the PR interval. Clinical implications of PR interval-guided ivabradine therapy remains the future concern.

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Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing

Cited by 9 publications

References 36 publications

Heart Rate Recovery: Up to Date in Heart Failure—A Literature Review

Heart Rate Recovery: Up to Date in Heart Failure—A Literature Review

A Comparative Analysis of Apical Rocking and Septal Flash: Two Views of the Same Systole?

PR Interval as a Novel Therapeutic Target of Ivabradine Therapy—Prognostic Impact of Ivabradine-Induced PR Prolongation in Heart Failure Patients

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